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NPI Code Detail

MEDICARE: MISS JENNIFER POE R.D.

MEDICARE: MISS JENNIFER POE R.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianND 4572FL

General Provider Information

NPI Number : 1801842513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER POE R.D.
Provider Business Mailing Address
First Line : 200 SANDESTIN LN
Second Line :
City : DESTIN
State : FL
Zip : 32550-5834
Country : US
Telephone Number : 850-622-3211
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MAR WALT DR
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-6708
Country : US
Telephone Number : 850-863-7522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/08/2007

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Directions to “ MISS JENNIFER POE R.D.” Practice Location

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